WHERE ARE
THE GIRLS WITH ADHD ?
Dr Ernest Luk, Associate Professor of Psychological Medicine at Monash University was our guest speaker at the October 28 meeting of ACTIVE Inc. Here is a summary of his talk.
Men and women refer themselves to clinics for treatment for Attention Deficit Disorder [with or without hyperactivity] in roughly equal proportions. But in children’s clinics, the proportion of boys to girls is many times higher. How can this be explained ?
Statistics from a major study of several thousand Australian children [The Australian Temperament Project] indicate that there are about 2.5 boys with the symptoms of ADHD for every girl in the population as a whole. However, the Travancore Child and Family Centre in Melbourne finds that there are 9 times as many boys referred for ADHD symptoms as girls.
TEACHER BIAS
Are adults more likely to rate boys as having a higher level of activity than girls when they are, in fact, identical ?
Dr Eric Taylor, Professor of Child and Adolescent Psychiatry in London has completed a study [as yet unpublished] which examines the question of possible gender bias. Using an actometer, [a device that objectively measures the rate of activity of a person], Dr Taylor studied boys and girls who were rated equally by teachers in terms of their level of activity and compared their activity levels using an actometer. He found that the actometer rated the activity level of the boys as, on average, higher than the girls. Dr Taylor hypothesised that there is indeed a tendency for boys to have a higher level of activity than girls.
‘DOUBLE DOSE’ THEORY
Do girls have ADHD less often than boys but have it more severely when they do ? Could it be a sex-linked gene where girls may be able to receive twice the genetic inheritance for ADHD as boys ? Dr Luk discounts this theory. "If it were true, we would expect to find a higher prevalence of ADHD in the close relatives of girls with extreme ADHD. But this is not the case," he said. A surprise finding of Dr Taylor’s study was that the girls with hyperactivity had, on average, a lower IQ than the boys with hyperactivity
ATTENTION DEFICIT, HYPERACTIVITY
AND GENDER
By now we have become used to thinking of attention deficit, hyperactivity and impulsivity as forming a discrete syndrome [ADHD]. But these symptoms may occur in different combinations and proportions in the female and male populations. Dr Luk hypothesised that pure attention deficit disorder without hyperactivity/impulsivity may be much more common in females Fewer girls than boys have the combination of hyperactivity, impulsivity and attention deficit.. A small proportion have the combination of hyperactivity and impulsivity alone.
By contrast, in the male population, a combination of hyperactivity, impulsivity and attention deficit is common in the population affected with any of the above symptoms. While pure attention deficit disorder is the commonest form of the disorder in girls, in boys it is less common. The proportion who have a combination of attention deficit and impulsivity alone may be roughly comparable to that in girls.
DIAGNOSES MISSED
These facts may explain why so many girls are missed, as attention deficit alone is less obvious to the onlooker than hyperactivity and impulsivity. It may also mean that we are missing many boys who have pure attention deficit.
ADULTS
"Despite these differences," said Dr Luk, "it is well known that equal numbers of men and women seek help for ADHD". The author Sari Solden [Women With Attention Deficit Disorder] offers an explanation. Solden argues that the cultural expectations on women with ADHD mean that they are even more disadvantaged than men. as they are expected to play an organising and co-ordinating role as wives and mothers. Their difficulties lead them to failure in these roles and they are often heavily burdened with guilt. It may be therefore, that there are fewer women with ADHD but that they are more likely to seek treatment.
CULTURE AND AGGRESSION
Some cultures, [e.g. Asian cultures] may be suppressing female aggression more than others. The activity of girls may also be viewed differently in different cultures. Girls with hyperactivity may be seen as spontaneous, active, loving, and a delight. In schools, teachers are more likely to notice boys because of disruptiveness. This may be a reason why girls are less likely to be referred than boys. If they are not aggressive, they are seen as less of a problem.
RESPONSE TO TREATMENT
"In general, girls respond better to treatment than boys," said Dr Luk. "However, parents are sometimes reluctant to accept medication for girls as they feel that they can manage the girls. We are noticing that in the clinics we are seeing more girls at an older age than the boys. Undetected and untreated ADHD in childhood can lead to ongoing difficulties later."
AUDIENCE QUESTIONS
Many women don’t present to clinics because they are not able to find any professional who understand the problem.
Dr Luk: Yes. It’s a problem. Also from a research point of view, if they don’t present, they are not able to be studied and so the services to them do not improve.
Our daughter attended a co-educational school. Compared with the boys, she was not hyperactive. But when we changed her to a single-sex school, it became obvious that she was hyperactive.
Dr Luk: Yes. We need to help parents and professional to understand this phenomenon.
Where can adults go to be diagnosed and treated ?
Dr Luk: I guess you had better ring ACTIVE for that.